Just 64 Nursing Homes Had No COVID Outbreak; Most Outbreaks Started with Staff

Out of thousands of nursing homes across the country, just 64 were able to go from May 2020 to this January without an outbreak of COVID-19, the U.S. Government Accountability Office (GAO) found in a study released on Wednesday.

And out of the 13,380 nursing homes reviewed in the study, 94% experienced more than one outbreak of COVID-19, the GAO found, with a significant portion of outbreaks lasting five weeks or more.

“For each nursing home’s longest-lasting COVID-19 outbreak, about 85% (11,311 nursing homes) had outbreaks lasting five or more weeks,” the study noted.


GAO is the watchdog arm of Congress, and under the CARES Act passed last year was charged with monitoring the federal response to the pandemic. It will produce other reports examining the experiences of nursing homes with outbreaks.

In addition, staff cases of COVID-19 started outbreaks of both long and short duration for 8,720 nursing homes, or 66% of facilities reviewed. A “long-duration outbreak” lasted five or more weeks, while “short-duration outbreaks” lasted one to four weeks, GAO noted in its study.

Bar chart showing duration of COVID-19 outbreaks in nursing homes reviewed by GAO, with short-duration outbreaks on top and long-duration ones on the bottom.
Source: GAO

The report dramatically quantifies the impact of the global pandemic on nursing homes; just 6% of nursing homes, or 761 facilities, had only one outbreak from May 2020 to January 2021, while 30% of nursing homes, or 4,026 facilities, had three outbreaks.


Out of the 11,311 nursing homes that had long-duration outbreaks, 7,810 had outbreaks of eight weeks or more.

“The majority of these long-duration outbreaks started between October and December 2020 — generally consistent with a period of time where weekly case and death counts in nursing homes increased to their highest points since the start of the pandemic,” the GAO said.

The study found that nursing homes with long-duration outbreaks were more likely to have higher bed counts than those with short-duration outbreaks. While homes with less than 50 beds accounted for just 12% of the nursing homes in the GAO’s review, they accounted for 28% of nursing homes with short-duration outbreaks and just 9% of homes with long-duration outbreaks.

The exact opposite was true for nursing homes with 100 to 199 beds, which accounted for 44% of the homes reviewed by the GAO – and comprised 27% of homes with short-duration outbreaks and 47% of homes with long-duration outbreaks.

“In part, this reflects the fact that larger homes will inherently incur a higher risk of having at least one case, given that they have more residents and staff, each of whom could become that case,” the GAO noted. “In addition, studies have shown that larger nursing homes with more beds and, subsequently, more residents and staff, may have a higher risk of exposure to COVID-19 — particularly in areas of high community spread — and thus greater potential for more people in the facility to become infected.”

In addition, the GAO did not find “notable differences” in the distribution of nursing homes cited with infection prevention and control deficiencies before the pandemic, in terms of nursing homes with long- and short-duration outbreaks. This was because most nursing homes in each of the groups had deficiencies cited between 2013 and 2019, the GAO said.

The GAO also did not find any relationship between a nursing home’s ownership status and its COVID-19 outbreak duration.

“We did not see differences between the homes with long- and short duration outbreaks and their ownership profit status (i.e., for-profit, non-profit, or government),” the agency wrote. “For example, nursing homes owned by for-profit organizations, which comprised 70% of all nursing homes in our review, also accounted for about 70% of nursing homes in each of these outbreak duration groups.”

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